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August 2003 |
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Dealing with disaster |  Back to contents | |
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Switch on the television, or open a newspaper, and it can often seem like the country is bracing itself for one potential disaster after another. If it isn't the threat of a severe acute respiratory syndrome (SARS) outbreak, there are reports about an imminent bio-terrorist or radiological dirty bomb attack, and recent years have seen a succession of incidents that have challenged emergency services. In 2001, foot and mouth devastated livestock and livelihoods in swaths of the rural community, and come winter severe flooding no doubt, will once again wreck havoc in some low-lying, urban areas. In both cases, large-scale disruption to communities has been huge and costly. Disease outbreaks and chemical incidents in particular are a serious concern because they can develop rapidly, which is why a well co-ordinated response is essential in minimising the disruption to everyday life. In all emergencies, the different agencies involved will need to understand their roles and pool their respective skills in order to work swiftly and effectively in tackling incidents, and act to bring the situation back to normal as soon as possible. On 1 April, a new national organisation for England and Wales, the Health Protection Agency, was set up to provide support for emergency bodies, and brings together the expertise of health and scientific professionals working in public health, communicable disease, emergency planning, infection control, laboratories, poisons, chemical and radiation hazards.1 Its emergence signals an important step change in terms of emergency planning and response. Prior to its inception, the various divisions that now constitute the agency, such as infectious diseases, and chemicals and poisons, had responded as separate organisations to emerging threats to health. Under the new management structure, these organisations have been brought together in a co-ordinated way to operate at a local, regional and national level and in doing so, provide a single identifiable health protection organisation for the NHS, the Government and other related agencies.2 This bringing together of the "component parts", notes Phil Luton, press officer at the HPA, Porton Down, has enabled the agency to "hit the ground running". The HPA, he adds, will provide an overreaching support role for emergency bodies, for example, by co-ordinating responses, providing training and testing of emergency plans, developing infrastructure for the early recognition of events, undertaking training exercises and developing computer modelling and horizon scanning. At the same time, preparations for strengthening responses to a wide range of incidents have been revised and stepped up at regional and local level. Last month, moves to modernise the UK's emergency planning system were unveiled when Douglas Alexander, minister for the Cabinet Office, published for consultation the long-awaited draft Civil Contingencies Bill. The proposals promise to deliver a single statutory framework for civil protection by updating existing legislation dating back to the 1920s. The Bill's strategic aim is to provide a "lasting and flexible basis for enhancing UK resilience". 3 Its proposals entail the following:
As noted last month (EHJ July 2003, page 210), the framework envisaged by the draft Bill will create a two-tier duty at the local level, which identifies local responder roles and responsibilities within the area of civil protection. Local authorities have been recognised in the proposals as having front line responsibilities for local contingency planning. However, the level of funding that will be allocated to local authorities remains an issue of contention.5 "The LGA welcomes these proposals," says Paul Read, Local Government Association consultant leading on emergency planning. "This is the first time that we have a framework of enabling legislation but without seeing how it will be funded, there is a worry over whether we can deliver." Mr Read warns that funding for emergency planning is already inadequate, and with the new duties requiring local emergency planning departments to provide information and education on risk management, emergency planning and business continuity,6 there will be an even greater burden on resources. The draft Bill builds on government action to strengthen arrangements for emergency planning and civil protection that followed the 2001 general election. In July 2001, the Cabinet Office created a new Civil Contingencies Secretariat (CCS) to pull together the Home Office's former responsibilities for emergency planning with a new capability at the heart of government to assess and respond to emergencies as they arise.7 The following month, the CCS published a comprehensive review of emergency planning arrangements in England and Wales. But it was the September 11, 2001 attacks that arguably have added a new dimension to planning arrangements, changing as they have people's understanding of terrorism and its potential for causing large-scale devastation. The attacks prompted the Government to launch a review of the UK's preparedness and contingency plans to deal with such incidents, resulting in the Anti-Terrorism, Crime and Security (ATCS) Act 2001. Since then, various measures have been put in place to improve levels of preparedness, most notably those dealing with chemical, biological, radiological or nuclear (CBRN) threats. Though incidents such as foot and mouth, the fuel crisis and flooding can all cause widespread disruption and damage, the attacks on New York and Washington arguably have made people more aware of the potential for terrorist activity using (in a worse case scenario) CBRN materials. But even so, the accidental release of CBRN materials should not be forgotten. After all, the most serious CBRN incident to impact on the UK in recent years was the Chernobyl nuclear accident in 1986.8 However, as the Home Office acknowledges in its strategic national guidance - The decontamination of people exposed to chemical, biological, radiological or nuclear substances or material, incidents that involve the accidental release of CBRN material or cases of naturally occurring disease outbreaks are likely to be on a more manageable scale than terrorist incidents due to the lack of intent, the limited nature of sites at risk and safety systems in place. The guidance raises some important issues, not least the fact that organisations have tended to plan on the assumption that they have adequate resources to handle one incident at any time. Yet the September 11 attacks have shown that multiple incidents may need to be dealt with simultaneously, perhaps even in the boundaries of a single authority. Planning, response and recovery is required to take place within the emergency planning structures set out in the existing national guidance, Dealing with disaster (or the equivalent guidance issued in the devolved administrations). An updated version of this document was published on the same day as the draft Civil Contingencies Bill and examines and compares the principles of co-operation which guide the multi-agency response to, and management and resolution of, a major incident.9 As explained in last month's bio-terrorism article, the principal role of the local authority in the initial phase of an incident is to support the emergency services, and continue normal services to the local community. However, once the emergency services have left the incident scene, the local authority will take on the lead role in the rehabilitation and reconstruction of the community. Guidance on the handling of the recovery process can be found in the Home Office's Recovery: an emergency management guide. This guide says the transition from support to lead role is likely to be formalised through a multi-agency strategic co-ordination group (or "gold"), and may occur within hours, days, or even weeks of the incident. At this stage, "the chair of the strategic co-ordination group" is handed over by the police to the local authority.10 This is an important point to consider. As this period is unpredictable, and because the lead role in the recovery process is likely to place huge demands on local authority resources and manpower, the guidance says that preparations for this phase will need to be organised sometime before the hand over. The overall aim of recovery is to "reach a point where additional demands on services have been reduced to the level at which they were before the incident occurred", otherwise known as "a return to normality". Five key aspects of recovery are identified in the guidance:
While an in-depth discussion of these "aspects of recovery" is beyond the scope of this article (and can be gleaned from the Home Office guide), it is important to consider some of the key issues they raise, particularly as environmental health officers will be on the front line, feeding information to the community, co-ordinating services with other agencies, and responding to media inquiries. Incidents with the potential to cause large-scale damage and widespread contamination or pollution will obviously pose the greatest demands on local authorities for a number of reasons. To begin with, this type of incident is particularly emotive since it may result in fatalities and significant disruption to the community. Consequently, the incident will require sensitive handling by the authorities, which will be expected to respond to the community's growing needs and demands. At the same time, media and public interest in the local authority's handling of the incident is likely to increase. Local authorities' response to an incident can be complicated if communication with the Government becomes a casualty (EHJ August 2001, page 234). When incidents happen, the public often sees local government as an extension of central government. Where contamination of an area has taken place, local authorities will come under immense pressure to act promptly to decontaminate sites. Remediation however, may last long into the recovery phase and environmental monitoring and sampling may also be required over the long term. Needless to say there are serious resource issues to consider here. Furthermore the cost of remediation will present local authorities with a difficult choice between undertaking the work or closing the area to the public, and permanently re-housing the residents. As Dai Brogden, Buckinghamshire County Council emergency planning officer, says "providing temporary accommodation for 24-48 hours is one thing, but having to re-house large numbers of people over the long term will present a whole range of problems." Here he sees EHOs playing a vital role. "I don't think the role of EHOs has been really developed properly," he says. "They are going to be really important players in the recovery process because of their ability to consider the wider health issues." Mr Brogden is a member of the Emergency Planning Society, a professional body that represents a wide range of professionals who are involved in crisis, emergency or disaster planning and management. He feels that the environmental health skills base has a lot to offer emergency planners, and although a few EHOs are members of the Emergency Planning Society, he says the body would benefit greatly if more environmental health practitioners became involved.11 With the Civil Contingencies Bill now open to public consultation, interested parties have until 11 September to submit any comments and views. Though the proposals have been largely welcomed by local authorities, concerns over whether local emergency planning departments will be able to fulfil all of the duties proposed without increases in budgets remains an outstanding issue.12 For EHOs responding to an incident, a greater understanding of emergency planning is vital. Though the EHO role is not always clearly defined, they will be valued players in any emergency. References
Readers may be interested in purchasing the WHO publication Environmental
health in emergencies and disasters - a practical guide, edited
by B Wisner and J Adams, ISBN 92 4 154541 0, priced £40 +
p&p. For more information, e-mail: customer.services@theso.co.uk
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